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Osteoporosis overview

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These are the paths in the Osteoporosis pathway:

Osteoporosis HAI

About

What is covered

This pathway covers NICE guidance on osteoporosis in adults (18 years and older), including assessing the risk of fragility fracture and drug treatment for the primary and secondary prevention of osteoporotic fragility fractures.
Osteoporosis is a disease characterised by low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.
Fragility fractures are fractures that result from mechanical forces that would not ordinarily result in fracture (equivalent to a fall from a standing height or less), known as low-level (or 'low energy') trauma.
Reduced bone density is a major risk factor for fragility fractures. Other factors that may affect risk of fragility fractures include the use of oral or systemic glucocorticoids, age, sex, previous fractures and family history of osteoporosis. Because of increased bone loss after the menopause in women, and age-related bone loss in both women and men, the prevalence of osteoporosis increases markedly with age. As the longevity of the population increases, so will the incidence of osteoporosis and fragility fracture.
Fragility fractures occur most commonly in the spine (vertebrae), hip (proximal femur), and wrist (distal radius). They may also occur in the arm (humerus), pelvis, ribs and other bones. Major osteoporotic fractures are defined as fractures associated with low bone mineral density (BMD) and includes clinical spine, forearm, hip or shoulder fractures.
Osteoporotic fragility fractures can cause substantial pain and severe disability, often leading to a reduced quality of life. Hip and vertebral fractures are associated with decreased life expectancy. Hip fracture nearly always requires hospitalisation and can be fatal or permanently disabling. There are a number of therapies and treatments available for the prevention of fragility fractures in people who are thought to be at risk, or to prevent further fractures in those who have already had one or more fragility fractures.
Identifying who will benefit from preventative treatment is imprecise. A number of risk assessment tools are available to predict fracture incidence over a period of time, and these may be used to aid decision-making. This pathway provides guidance on the selection and use of risk assessment tools in the care of people who may be at risk of fragility fractures.

Updates

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

2 January 2014 Minor maintenance updates.
2 September 2013 The information about independent clinical risk factors has been removed from the section on denosumab in secondary prevention of osteoporotic fragility fractures in postmenopausal women on the 'Osteoporosis overview' path. The use of denosumab for the secondary prevention of osteoporotic fragility fractures in postmenopausal women (recommendation 1.2 of NICE technology appraisal guidance 204) does not depend on independent clinical risk factors.
14 May 2013 minor maintenance update.
25 April 2013 Minor update.
24 April 2013 Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for osteoporotic vertebral compression fractures (NICE technology appraisal guidance 279) added to a new node Treatment of vertebral compression fractures in the 'Osteoporosis overview' path.

Short Text

Osteoporosis

What is covered

This pathway covers NICE guidance on osteoporosis in adults (18 years and older), including assessing the risk of fragility fracture and drug treatment for the primary and secondary prevention of osteoporotic fragility fractures.
Osteoporosis is a disease characterised by low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.
Fragility fractures are fractures that result from mechanical forces that would not ordinarily result in fracture (equivalent to a fall from a standing height or less), known as low-level (or 'low energy') trauma.
Reduced bone density is a major risk factor for fragility fractures. Other factors that may affect risk of fragility fractures include the use of oral or systemic glucocorticoids, age, sex, previous fractures and family history of osteoporosis. Because of increased bone loss after the menopause in women, and age-related bone loss in both women and men, the prevalence of osteoporosis increases markedly with age. As the longevity of the population increases, so will the incidence of osteoporosis and fragility fracture.
Fragility fractures occur most commonly in the spine (vertebrae), hip (proximal femur), and wrist (distal radius). They may also occur in the arm (humerus), pelvis, ribs and other bones. Major osteoporotic fractures are defined as fractures associated with low bone mineral density (BMD) and includes clinical spine, forearm, hip or shoulder fractures.
Osteoporotic fragility fractures can cause substantial pain and severe disability, often leading to a reduced quality of life. Hip and vertebral fractures are associated with decreased life expectancy. Hip fracture nearly always requires hospitalisation and can be fatal or permanently disabling. There are a number of therapies and treatments available for the prevention of fragility fractures in people who are thought to be at risk, or to prevent further fractures in those who have already had one or more fragility fractures.
Identifying who will benefit from preventative treatment is imprecise. A number of risk assessment tools are available to predict fracture incidence over a period of time, and these may be used to aid decision-making. This pathway provides guidance on the selection and use of risk assessment tools in the care of people who may be at risk of fragility fractures.

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Service improvement and audit

These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.

Pathway information

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

2 January 2014 Minor maintenance updates.
2 September 2013 The information about independent clinical risk factors has been removed from the section on denosumab in secondary prevention of osteoporotic fragility fractures in postmenopausal women on the 'Osteoporosis overview' path. The use of denosumab for the secondary prevention of osteoporotic fragility fractures in postmenopausal women (recommendation 1.2 of NICE technology appraisal guidance 204) does not depend on independent clinical risk factors.
14 May 2013 minor maintenance update.
25 April 2013 Minor update.
24 April 2013 Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for osteoporotic vertebral compression fractures (NICE technology appraisal guidance 279) added to a new node Treatment of vertebral compression fractures in the 'Osteoporosis overview' path.

Supporting information

Glossary

Bone mineral density.
Dual-energy X-ray absorptiometry.
Standard deviations.

Paths in this pathway

Pathway created: August 2012 Last updated: January 2014

© NICE 2014

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